I sat down with my male colleagues (yes, again, all men) to negotiate our communication obstacles and discuss the situation of uterus prolapse in Nepal. Binot-ji, began by handing me flip charts and posters that explained the problem. Though I couldn’t understand the writing on them, they were accompanied by extensive cartoon drawings that illustrated many of the causes I learned about from the medical students. As only 35% of Nepali women can read (compared with 85% of men) all informational materials targeted at women have to include such illustrations to communicate their message.

The first phase of our discussion involved the men trying to help me understand how uterus prolapse was caused; aided by the visuals and my prior knowledge this task was fairly successful. We then moved on to they “why it is such a big problem” phase. They communicated it is a very pervasive problem affecting incredibly high proportions of women in Nepal. Subsequent internet research I did revealed several articles discussing the problem and conservatively placing the incidence at 10% of Nepali women.

– Fallen Womb: The Hardest Burden for a Woman to Bear
– Listening to “felt needs”: investigating genital prolapse in western Nepal
– Fact sheet on uterine prolapse

They also expressed concern and explained that uterus prolapse is causing a lot of social problems including something along the lines of divorce. The significant social ramifications of a medical problem surprised me and the simple response to my query about how this could lead to divorce came after a few minutes of discussion among themselves. One man turned to me and said “sexual satisfaction.” When I looked confused he continued sadly, “women much pain, men not satisfied take new wife.”

He further explained that this is a very bad situation for the women because if they are cast out by their husbands and their parents often won’t take them back due to economic hardship. This leaves such destitute women no other choice than to work as a servant in a home that will provide them food and shelter in exchange for their work – often becoming a servant to their husband and his new wife.

Just then Binot-ji who had been rustling around in his desk passed me a stack of pictures. I almost fell out of my chair. It was a stack of pictures of women their on backs (many on hardwood floors), with stick think legs and heels flexibly tucked into fleshless buttocks in a manner a yogi would envy. Yet they held a tension that belied their discomfort while they revealed their most intimate selves. In a shocked daze I flipped through several pictures of women in the early stages of prolapse with their parts looking essentially normal except for narrow slits of white at the center. As I continued through the stack my heart sank into my stomach.

Picture after picture showed protrusions of increasing size. The prolapses grew from the size of a lemon to an orange, to a grapefruit, and ultimately to a small cantelope. The larger ones had sores on the sides where the delicate tissue of the hanging uterus had become chaffed by walking thighs that rubbed against it. Many of the women pictured were clearly elderly, identifiable by wrinkled and leathery skin covering stringy muscles that hung off spindly legs and lacked any tone of youth.

Images flashed to mind of women I’ve been seeing throughout Nepal staggering under the weight of heavy loads balanced on the crown of their heads or wrapping from their foreheads down into woven baskets leaning against their backs.

I have been consistently amazed by the older subset of these women who appear so fragile yet are so strong and saddened by the need that makes them so. Realizing that many of them maintain despite intense pain and social disgrace was overwhelming.

Then I came across a set of pictures that was stapled together – first another uterus prolapse and then a picture of the woman it belonged to staring straight into the camera with a hollow expression and her saree draped over her head. It just was. Her lack of anonymity and courage truly stunned me.

By the end of the stack the tears had welled up and the damn was breaking. I put the pictures down, stepped outside, sank down in the shade on the concrete porch and sobbed. I was grieving for the shame and isolation these women feel, for the pain they endure, the stigma and trauma that can result from a preventable medical condition, that their ultimate worth is their means of sexual satisfaction for their husbands, and to top it all off, the fact that their most private and delicate parts were being casually passed around in full color for a roomful of strange men to inspect.

The wave passed and as I was sitting trying to collect myself and generate some dignity to rejoin the meeting Prakash gingerly walked up (for the second time) to see if was alright. Looking at my sadly he indicated that he had also looked at the pictures as well while I was outside and felt, “very sensitive.” He pumped some water for me to wash my face, I took a deep breath, and we went back inside. Thankfully, everyone was engaged in quiet side conversation and kindly didn’t stop when I walked in. After a few minutes we picked up right where we had left off. As I now had quite a grasp of the problem we moved on to the final phase of our conversation and discussed solutions.

They explained that different treatments are available for each of the phase – though the latter stages can only be addressed through surgery the earlier stages can be corrected through a combination of exercise, lifestyle modifications, and the insertion of an uncomfortable platex ring that is changed every 3 months and holds the uterus in place while the ligaments heal.

We then discussed the program CDF implemented in their district, their desire to make the program national, and the general lack of interest in addressing the problem.

With the help of an INGO “Safe Motherhood” CDF has made treatment and surgery available to all women living in the district, paying the costs for those who cannot afford it themselves. When I asked them why there was so little attention to the problem they sadly remarked “it is an issue that only concerns women,” and continued to give evidence about the lack of concern for women’s issues by explaining that the national head of the government’s Women’s Affairs is a man.

Finally, Binot-ji explained that CDF desperately want to make this issue one of the main focuses of their work and asked if I had any ideas about how to make the international community interested in helping with the problem. Simultaneously I felt completely overwhelmed and completely moved. I gave them my word that would give the situation serious though and would do whatever little bit I could to help raise awareness of the issue. Writing this blog has been the first step.